对Garden指数作为股骨颈骨折复位质量评价标准的再认识

Re-evaluation of Garden indexes as a criterion for reduction of femoral neck fracture:a cadaveric study

目的探讨Garden指数能否判断股骨颈骨折的旋转移位。方法取5具10侧健康股骨近端尸体标本,男3具,女2具;死亡年龄为45~70岁。于股骨头中心置入1枚直径为2.0 mm的克氏针,垂直于股骨颈中部截骨,在截骨处远端骨面标明旋转角度。在每侧标本上依次进行旋前及旋后0°、10°、20°、30°、40°、50°、70°、90°操作,并摄标本正、侧位X线片,利用影像归档和通信系统测量Garden指数,比较不同旋转角度下的正位、侧位Garden指数。同时观察在不同旋转角度下股骨头小凹面积的变化规律。结果从0°至旋前30°或旋后30°的过程中,正位、侧位Garden指数无明显变化,差异均无统计学意义(P>0.05),且数值均>155°。从旋前40°至旋前90°的过程中,正位Garden指数分别为152.36°±1.41°、146.04°±1.64°、143.95°±0.60°、141.73°±0.60°,侧位Garden指数分别为172.54°±0.86°、168.57°±0.98°、157.18°±1.17°、156.47°±1.63°,不同旋转角度之间比较差异均有统计学意义(P<0.05)。从旋后40°至旋后90°的过程中,正位Garden指数分别为151.67°±1.06°、147.32°±1.82°、142.77°±0.75°、139.88°±1.48°,侧位Garden指数分别为172.28°±0.79°、166.76°±1.02°、155.67°±1.74°、154.16°±1.27°,不同旋转角度之间比较差异均有统计学意义(P<0.05)。随着旋前角度的增大,股骨头小凹面积逐渐减少;随着旋后角度的增大,股骨头小凹面积逐渐增大。结论在0°~30°的旋前或旋后范围内,Garden指数无法准确判断股骨颈骨折复位时的旋转移位。股骨头小凹面积的变化可以辅助判断股骨颈骨折的旋转移位。

Objective To investigate whether the Garden indexes can serve as a criterion for rotational displacement of femoral neck fracture.Methods Ten cadaveric specimens of healthy human proximal femur were used for this study.They came from 3 males and 2 females who had died at the age from 45 to 70 years old.A Kirschner wire of 2.0 mm in diameter was implanted into the center of the femoral head.Osteotomy was conducted perpendicular to the middle line of the femoral neck.The rotational angles were marked on the distal osteotomy surface.Each cadaveric specimen was rotated sequentially at pronation and supination angles of 0°,10°,20°,30°,40°,50°,70°and 90°,respectively.X-ray images of anterior-posterior and lateral views were taken to record all the rotations of the specimens.Picture Archiving and Communication Systems(PACS)were used to measure the Garden indexes and compare them among anterior-posterior and lateral X-ray films of different pronation and supination angles.Changes in the area of the femoral head fovea at different rotation angles were observed as well.Results There were no significant differences in the auterior-posterior or latera Garden indexes from 0°to pronation or supination 30°,with all the Garden values>155°(P>0.05);from pronation of 40°to pronation of 90°,the Garden indexes were 152.36°±1.41°,146.04°±1.64°,143.95°±0.60°and 141.73°±0.60°for anterior-posterior views and 172.54°±0.86°,168.57°±0.98°,157.18°±1.17°and 156.47°±1.63°for lateral views,showing a significant difference between rotational angles(P<0.05);from supination of 40°to supination of 90°,the Garden indexes were 151.67°±1.06°,147.32°±1.82°,142.77°±0.75°and 139.88°±1.48°for anterior-posterior views and 172.28°±0.79°,166.76°±1.02°,155.67°±1.74°and 154.16°±1.27°for lateral views,showing a significant difference between rotational angles(P<0.05).The area of the femoral head fovea decreased gradually with the increase in pronation angle,and increased gradually with the increase in supination angle.Conclusions The Garden indexes cannot serve as an accurate indication of rotational displacement in reduction of femoral neck fracture when the pronation or supination angles ranges from 0°to 30°.Changes in the area of the femoral head fovea can help determine the rotational displacement of the femoral neck fracture.